Drug Enforcement Administration

Drug Distribution Investigation Uncovers Massive Health Care Fraud

Twelve Pharmacists, four doctors, an accountant, and a psychologist among those charged in scheme alleging criminal activity at over 20 pharmacies statewide

An indictment returned by a federal grand jury in Detroit was unsealed today, charging 26 individuals for their participation in a large-scale health care fraud and drug distribution scheme, United States Attorney Barbara L. McQuade announced today. McQuade was joined in her announcement by Special Agent in Charge Robert L. Corso of the U.S. Drug Enforcement (DEA), Special Agent in Charge Andrew G. Arena of the Federal Bureau of Investigation, and LaMont Pugh, Special Agent in Charge of the Inspector General of the Department of Health and Human Services.

"Confronting the illegal diversion and abuse of controlled pharmaceuticals is a top priority of DEA and our law enforcement partners. Today's arrests and the allegations in the indictment bring to light one of the largest diversion conspiracies ever uncovered in the state of Michigan,” said Robert L. Corso, Special Agent in Charge of DEA's Detroit Field Division. “The allegations against these 26 individuals, particularly of the medical professionals, are significant. These individuals abused their positions of trust and endangered the lives of countless people by illegally distributing more than 6 million doses of opiate painkillers and depressants throughout southeast Michigan and beyond. This indictment makes it clear that the DEA and our partners in law enforcement will continue to investigate and bring to justice those individuals that are responsible for the illegal distribution of prescription medicines."

"Health care fraud steals funds from programs designed to benefit patients, and we all pay for it," U.S. Attorney McQuade said. "Federal and state investigators have teamed up in recent months to detect and prosecute those who commit health care fraud, and we hope that the strength of our efforts will have a deterrent effect."

“Health care fraud and the abuse/diversion of prescription medications are increasing criminal threats to the United States,” said FBI Special Agent in Charge Arena. “Dishonest health care providers involved in fraudulent activities frequently exploit Medicare and Medicaid through fraudulent billing schemes which abuse tax payer's dollars. The FBI remains committed to investigating this type of fraud and bringing these individuals to justice.”

The 34‑count indictment alleges that Babubhai "Bob" Patel, 49, a Canton pharmacist, was the beneficial owner and controller of some 26 pharmacies (referred to in the indictment as "the Patel Pharmacies"). Babubhai Patel concealed his ownership and control over many of the Patel Pharmacies through the use of straw owners. The indictment alleges that Babubhai Patel would offer and pay kickbacks, bribes, and other inducements to physicians, in order to induce those physicians to write prescriptions for patients with Medicare, Medicaid, and private insurance, and to direct that those prescriptions be presented to one of the Patel Pharmacies for billing.

In exchange for their kickbacks and inducements, the medical professionals would write prescriptions for the patients, and bill the relevant insurers for services supposedly provided to the patients, without regard to the medical necessity of those prescriptions and services. The physicians would direct the patients to fill their prescriptions at one of the Patel Pharmacies. There, according to the indictment, Babubhai Patel and his pharmacists would bill insurers, including Medicare, Medicaid, and private insurers, for dispensing the medications, despite the fact that the medications were medically unnecessary and/or never provided. Patients were recruited into the scheme by patient recruiters, who would pay kickbacks and bribes to patients in exchange for the patients' permitting the Patel (and the physicians associated with Patel) to bill their insurance for medications and services that were medically unnecessary and/or never provided.

The indictment further alleges a conspiracy to distribute controlled substances at the Patel pharmacies, a purpose of which was to facilitate the submission of false and fraudulent claims to Medicare, Medicaid, and private insurers in accordance with the scheme outlined above. According to the indictment, Babubhai Patel and his associates paid physicians and podiatrists associated with the scheme kickbacks and other inducements in exchange for the medical professionals writing prescriptions for controlled substances for their patients, and directing those patients to fill the prescriptions at a Patel Pharmacy. The controlled substances involved included the Schedule II drug OxyContin, the Schedule III drug Vicodin, the Schedule IV drug Xanax, and the Schedule V drug cough syrup with codeine. According to the indictment, prescriptions for these drugs were written outside the course of legitimate medical practice. Babubhai Patel and his pharmacists would then dispense the controlled drugs to patients without medical necessity. The distribution of controlled substances in this manner was intended, in part, as a kickback to the patients for agreeing to enable their insurance cards to be billed for medications purportedly dispensed at the Patel Pharmacies. The indictment also alleges that Babubhai Patel and his pharmacists dispensed controlled substances outside the scope of legitimate medical practice to patient recruiters, as a kickback for their efforts to recruit patients into the scheme.

According to the indictment, the Patel Pharmacies billed the Medicare program not less than $37.7 million for medications purportedly provided to Medicare beneficiaries over the course of the (since January 2006), and not less than $20.8 million for medications purportedly provided to Medicaid beneficiaries over the course of the scheme. The indictment further alleges that since January of 2009, the Patel Pharmacies have dispensed not less than 250,000 doses of Oxycontin, not less than 4.6 million doses of Vicodin, not less than 1.5 million doses of Xanax, and not less than 6,100 pint bottles of codeine cough syrup.

The investigation of this case was handled by the DEA, the Federal Bureau of Investigation, and the Department of Health and Human Services Office of Inspector General. Assisting in the investigation were the United States Marshal Service, Homeland Security, Immigration and Customs Enforcement, the Michigan Attorney General's Office, the State of Michigan Department of Community Health, Gross Ile Police Department, River Rouge Police Department, Livonia Police Department, Livingston County Sheriff's Department, Dearborn Heights Police Department and the Clinton Township Police Department. The case is being prosecuted by Assistant U.S. Attorneys John K. Neal and Wayne F. Pratt.

An indictment is only a charge and is not evidence of guilt. A defendant is entitled to a fair trial where it will be the government’s burden to prove guilt beyond a reasonable doubt.